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M. Juliana "Julie" McElrath (born January 9, 1951) is a senior vice president and director of the vaccine and infection disease division at Fred Hutchinson Cancer Research Center and the principal investigator of the HIV Vaccine Trials Network Laboratory Center in Seattle, Washington. [1] [2] She is also a professor at the University of Washington. [3]
McElrath has built and maintains an international HIV vaccine laboratory, contributing to the fundamental understanding of how HIV-1 – the most common and pathogenic strain of the virus – enters the mucosa to infect people. [4] Her work centers on developing an HIV vaccine and investigating the complex relationship between HIV and the immune system. She is supported in part by the National Institutes of Health and the Bill & Melinda Gates Foundation. [1]
McElrath obtained a B.S. in biology from Furman University, a Ph.D. in pathology, and an M.D. from the Medical University of South Carolina. [1] After completing her residency in internal medicine, she received her clinical fellowship training in infectious diseases at Columbia Presbyterian Medical Center in New York and her post-doctoral training in molecular immunology at Rockefeller University in New York. [1]
During the early 1980s, while working as a medical resident in the city of Charleston, South Carolina, McElrath became inspired to research HIV/AIDS after caring for many young patients who were dying from a mysterious illness that, ultimately, was identified as acquired immune deficiency syndrome, or AIDS. [1] This desire became more urgent as she focused on infectious diseases in New York City. [5]
In 1988, she was named an assistant professor at Rockefeller University. In 1990, McElrath relocated to Seattle to take a position at the University of Washington as an assistant professor and to direct the HIV AIDS Madison Clinic at Harborview Medical Center. Within two years, she shifted her focus back to the bench to pursue the path to an HIV vaccine. [6] She became the director of the AIDS Vaccine Evaluation Unit at the University of Washington. [6]
In 2000, while driving through villages in the coastal areas near Durban, South Africa, she saw the tangible toll of the AIDS epidemic. Elderly women were cradling crying babies and teenagers were tending to children – the orphaned survivors of a decimated generation, she recalled in an interview. [7] At the same time, a large percentage of people in the region also were known to be infected with HIV. She later described the situation as "terribly sobering." [7]
In 1996, McElrath joined the faculty at Fred Hutchinson Cancer Research Center, bringing her work toward an HIV vaccine to the center. She was honored for her research with an NIH Merit Award and served as associate editor of the Journal of Infectious Diseases. [6] Over time, she became a full professor at the University of Washington, a full member at Fred Hutch, and the director of the HIV Vaccine Trials Network (HTVN) Laboratory Center. Headquartered at Fred Hutch, HVTN is the world's largest network dedicated to testing vaccines designed to prevent HIV. [8]
The finding launched a push to better understand how the trial vaccines prevented HIV and how they could be improved. That initiative became a major focus of the HVTN's lab program, headed by McElrath. The Thai trial led McElrath, her colleagues and collaborators at Duke University and the Henry M. Jackson Foundation for the Advancement of Military Medicine to make a pivotal discovery. For the first time, they pinpointed "immune correlates" that were associated with reduced HIV risk. One of their key findings suggested the vaccines might spur some recipients to make antibodies that prevent HIV infection. McElrath's quest to develop an HIV vaccine spurred her effort to launch a new immunology lab Cape Town, South Africa. That facility opened its doors in 2013. [7]
In addition to her work with HVTN and at Fred Hutch, McElrath is an attending physician at Harborview Medical Center, the University of Washington Medical Center, and Seattle Cancer Care Alliance, the treatment arm of Fred Hutch. She has published nearly 300 papers in peer-reviewed journals, the majority on HIV/AIDS. In 2007, she co-founded the Vaccine Infectious Disease Institute at Fred Hutch and has served as the sole director of the Vaccine and Infectious Disease Division at Fred Hutch since 2011. [1]
McElrath's scientific interests include investigations to understand the human immune responses that control and prevent HIV-1 infection by using multi-disciplinary and cross-platform approaches. [9] She continues to be involved in a global initiative to develop an HIV-1 vaccine, and in research to identify innate and mucosal immune defenses generated following vaccination. [10] McElrath has taken a leadership role or has been a significant contributor to numerous integrated programs at the national and international level to advance a coordinated effort to curb the HIV epidemic through prevention efforts. Those include: the HIV Vaccine Trials Network, the Gates Foundation Innate Immunity Consortium (PI), the Microbicide Trials Network (Director, Immunology Core), and the Seattle Vaccine Trials Unit (PI). [11]
At the McElrath Laboratory at Fred Hutch, a primary goal is to determine how T cell memory is induced both in natural infection and by immunization. McElrath and her team also are working to identify the properties of T cells that confer containment or eradication of HIV-1. [12] Their studies span a wide array of immunologic investigations in persons who experience unusual control of HIV-1 infection, including individuals with newly diagnosed infection, those with long-term non-progressive disease who control infection for more than a decade without antiretroviral treatment, and people repeatedly exposed but not infected. [13] These clinical cohorts have been assembled for longitudinal studies in both Seattle and in two nations where the HIV epidemic is widespread – South Africa and Uganda. [14]
On Dec. 1, 2015, the work of McElrath and HTVN scientists pursuing a vaccine to potentially halt HIV and AIDS will be highlighted in an HBO/VICE special report titled "Countdown to Zero." [15]
McElrath is a member of the Association of American Physicians, American College of Physicians and the Infectious Diseases Society of America. She is a past recipient of the Burroughs Wellcome Clinical Scientist Award in Translational Research, a National Institutes of Health Merit Award, and the GAIA Vaccine Foundation Award. She serves on numerous scientific advisory committees and boards for institutions, government and industry. [16]
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The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same-sex and opposite-sex partners so long as the HIV-positive partner maintains an undetectable viral load.
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Envelope glycoprotein GP120 is a glycoprotein exposed on the surface of the HIV envelope. It was discovered by Professors Tun-Hou Lee and Myron "Max" Essex of the Harvard School of Public Health in 1984. The 120 in its name comes from its molecular weight of 120 kDa. Gp120 is essential for virus entry into cells as it plays a vital role in attachment to specific cell surface receptors. These receptors are DC-SIGN, Heparan Sulfate Proteoglycan and a specific interaction with the CD4 receptor, particularly on helper T-cells. Binding to CD4 induces the start of a cascade of conformational changes in gp120 and gp41 that lead to the fusion of the viral membrane with the host cell membrane. Binding to CD4 is mainly electrostatic although there are van der Waals interactions and hydrogen bonds.
A T-cell vaccine is a vaccine designed to induce protective T-cells.
HIV superinfection is a condition in which a person with an established human immunodeficiency virus infection acquires a second strain of HIV, often of a different subtype. These can form a recombinant strain that co-exists with the strain from the initial infection, as well from reinfection with a new virus strain, and may cause more rapid disease progression or carry multiple resistances to certain HIV medications.
Antibody-dependent enhancement (ADE), sometimes less precisely called immune enhancement or disease enhancement, is a phenomenon in which binding of a virus to suboptimal antibodies enhances its entry into host cells, followed by its replication. The suboptimal antibodies can result from natural infection or from vaccination. ADE may cause enhanced respiratory disease, but is not limited to respiratory disease. It has been observed in HIV, RSV, and Dengue virus and is monitored for in vaccine development.
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